Period: Profile Type: Adults (18-64 Years) Non-MAT€¦ · Hub Regional Profile Period: Jan. 2017 - Dec. 2017 Profile Type: Adults (18-64 Years) ... More detail on this measure is

Hub Regional Profile Period: Jan. 2017 - Dec. 2017 Profile Type: Adults (18-64 Years)

Welcome to the 2017 Blueprint Hub RegionalProfile of the Vermont Hub & Spoke Program,

which provides Medication AssistedTreatment (MAT) to Vermonters with opioiduse disorder (OUD). The Blueprint for Health,in partnership with the Vermont Department

of Health's Division of Alcohol and DrugAbuse Programs, offers this statewide view of

the Program.

The Hub & Spoke Program is a systematictreatment response to the opioid epidemic in

Vermont. This program enhances theprovision of MAT by adding new health care

staff to both Hub-designated providers andthe Spokes to provide Health Home (HH)

services. These new staff link OUD treatmentwith Blueprint primary care practices andCommunity Health Teams to provide care

that is evidence based and integrated.

The Hub Regional Profiles providecomparative measurement to inform quality

improvement at local and statewide levels.Hubs are regional, specialty OUD treatment

centers regulated as Opioid TreatmentPrograms (OTPs) that provide intensive

treatment of OUD as well as consultation andsupport to the Spoke teams of health care

professionals offering MAT.

Blueprint Hub Regional Profiles are based ondata from Vermont's all-payer claims database (VHCURES) and the Vermont Clinical

Registry. The population in this profile isMedicaid beneficiaries, including those withdual Medicare and Medicaid eligibility, ages

18-64 years with OUD who received themajority of their MAT treatment in a Hub in

2017.

The measure results in the profile have notbeen risk adjusted unless specifically noted.

Results with fewer than eleven members arenot reported, consistent with Medicare

guidelines.

This profile is intended to be read with therelated methods documentation.

Demographics & Health Status

Hub SpokeNon-MAT

OUDMedicaid

Statewide

Distinct Members 3,395 3,690 2,062 98,498

Average Members 3,214 3,540 1,853 89,362

Average Age (In Years) 35.6 35.0 37.1 38.8

% Dual Eligible 10.0 9.3 15.1 12.9

% Female 49.7 52.6 47.6 53.6

% Maternity 10.0 13.8 8.0 8.8

% CRG Significant Chronic 40.1 49.5 41.0 27.0

% Hepatitis C 18.5 12.8 11.5 2.3

% Asthma 17.7 18.6 18.8 12.6

% Mental Health (Non-Substance Use) 56.1 64.9 63.2 35.7

% Depression 29.9 31.8 34.3 16.6

% ADHD 14.0 13.8 9.4 4.0

% Other Substance Use 39.5 40.8 45.0 11.0

% Current Year Pain 22.3 24.3 34.5 18.5

% Incarcerated 19.8 13.5 19.1 3.4

% Both Hub and Spoke 9.4 8.3 0.0 0.6

Table 1: This table provides comparative information on the demographics and health status of allMedicaid members of the Hub program. For comparison, it also includes demographic and health statusinformation for Medicaid beneficiaries with OUD who did not receive treatment in either a Hub or Spoke in2017. For context, the table also provides demographic informationfor the general Medicaid populationstatewide.

Average Members serves as this table's denominator and adjusts for partial lengths of Medicaidenrollment during the reporting period. Average membership is calculated as the proportion of themeasurement period that an individual was covered by Medicaid.

Current year pain was identified using a Blueprint-developed algorithm that considers a member's chronicpain diagnoses, musculoskeletal and migraine conditions associated with pain, and prescriptions used totreat pain (e.g., nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, opiates) in the reportingperiod. More detail on this measure is included in the profile documentation.

The Health Status (CRG) measure aggregates 3M™ Clinical Risk Grouper (CRG) classifications for thereporting period for the purpose of generating adjusted rates. Aggregated risk classification groupsinclude: Healthy, Acute (e.g., ear, nose, throat infection) or Minor Chronic (e.g., minor chronic joint pain),Moderate Chronic (e.g., diabetes), Significant Chronic (e.g., diabetes and congestive heart failure), andCancer (e.g., breast cancer, colorectal cancer) or Catastrophic (e.g., HIV, muscular dystrophy, cysticfibrosis). Since most members with OUD fall into the chronic category with a detail CRG indicating OUD, wedistinguish the less healthy population as having a CRG aggregate category of Significant Chronic orhigher.


Total Expenditures per Capita

Figure 1: Presents annual crude rates, including 95% confidence intervals,with expenditures capped statewide for outlier patients. Expendituresinclude all health care claims paid by Medicaid as well as dually eligiblemembers' claims paid by Medicare. The blue dashed line indicates the Hubstatewide average.

Total Expenditures, Risk-Adjusted Across Hub Regions

Figure 2: Presents annual risk-adjusted rates, including 95% confidenceintervals, with expenditures capped statewide for outlier patients.Expenditures include all health care claims paid by Medicaid as well as duallyeligible members' claims paid by Medicare. The blue dashed line indicatesthe Hub statewide average.

Total OUD Treatment & Other Healthcare Expenditures (PMPY)

Figure 3: Presents annual crude rates for Medication Assisted Treatment (MAT) expenditures (e.g. Spoke Staff, MAT Treatment), urinalysisexpenditures, professional opioid use disorder (OUD) expenditures, and non-MAT expenditures with expenditures capped statewide for outlierpatients.


Total OUD Expenditures by Treatment Category (PMPY)

Figure 4: Presents annual crude rates for the major components of Medication Assisted Treatment (MAT) expenditures as well as urinalysisexpenditures with expenditures capped statewide for outlier patients.

All Other Health Care Expenditures by Major Category (PMPY)

Figure 5: Presents annual crude rates for the major expenditure categories for health and OUD care with expenditures capped statewide for outlierpatients. Special Medicaid Services are services that commercial insurance often does not cover (e.g., transportation, special school services,residential treatment, etc.) and are reported separately.


Inpatient Discharges*

Figure 6: Presents annual crude rates, including 95% confidence intervals, ofinpatient discharges per 1,000 members. The blue dashed line indicates theHub statewide average.

Inpatient Discharges, Risk-Adjusted Across Hub Regions

Figure 7: Presents annual risk-adjusted rates, including 95% confidenceintervals, of inpatient discharges per 1,000 members. The blue dashed lineindicates the Hub statewide average.

Outpatient ED Visits*

Figure 8: Presents annual crude rates, including 95% confidence intervals, ofoutpatient emergency department (ED) visits per 1,000 members. The bluedashed line indicates the Hub statewide average.

Outpatient ED Visits, Risk-Adjusted Across Hub Regions

Figure 9: Presents annual risk-adjusted rates, including 95% confidenceintervals, of outpatient emergency department (ED) visits per 1,000members. The blue dashed line indicates the Hub statewide average.

*These measures are included in the Centers for Medicare & Medicaid Services Health Home reporting.


Advanced Imaging (MRIs, CT Scans)

Figure 10: Presents annual crude rates, including 95% confidence intervals,of advanced imaging diagnostic tests (i.e., magnetic resonance imagings(MRIs) and computed tomography (CT) scans) per 1,000 members. The bluedashed line indicates the statewide Hub average.

Focus: Members Who Utilized Both Hub and Spoke Services in 2017

Grouped by Where They Received a Plurality of Care

Metric Attributed to Hub Attributed to Spoke Overall

Average members 302 298 600

Annual expendituresper capita

$22468 ($20205, $24732) $24413 ($22239, $26587) $23434 ($21866, $25001)

Inpatienthospitalizations per

1,000 members628 ( 539, 717.8) 490 ( 411, 569.6) 560 ( 500, 619.6)

Inpatient days per1,000 members

4045 (3818, 4272) 3142 (2941, 3343) 3597 (3445, 3749)

Outpatient ED visitsper 1,000 members

1707 ( 1560, 1854) 1323 ( 1192, 1453) 1516 ( 1418, 1615)

Primary care visitsper 1,000 members

7565 ( 7255, 7875) 9060 ( 8718, 9401) 8307 ( 8076, 8537)

Table 2: Presents annual crude expenditures and utilization rates, including 95%confidence intervals, of members who had at least one Hub visit and at least oneSpoke visit in the measurement year. Members were attributed to either a Hub or aSpoke based on the plurality of care and are included in the statewide Hub and Spokerates throughout the profiles. Please refer to the supporting documentation for moredetail on the attribution methodology.


Adult Body Mass Index Assessment*

Figure 11: Presents the proportion, including 95% confidence intervals, ofcontinuously enrolled members with an outpatient visit whose body massindex (BMI) was documented during the measurement year or the year prior.This figure includes only practices providing clinical data to the VermontClinical Registry. Hubs do not report to the Clinical Registry. The blue dashedline indicates the Hub statewide average. The data label representsindividuals for whom data was available (denominator).

Screening for Clinical Depression*

Figure 12: Presents the proportion, including 95% confidence intervals, ofcontinuously enrolled members that were screened for clinical depression onthe date of encounter using an age-appropriate standardized depressionscreening tool. This figure includes only practices providing clinical data tothe Vermont Clinical Registry. Hubs do not report to the Clinical Registry. Theblue dashed line indicates the Hub statewide average. The data labelrepresents individuals for whom data was available (denominator).

Controlling High Blood Pressure*

Figure 13: Presents the proportion, including 95% confidence intervals, ofcontinuously enrolled members with hypertension that had controlled bloodpressure (<140/90 mmHg) during the measurement year. This figure includesonly practices providing clinical data to the Vermont Clinical Registry. Hubsdo not report to the Clinical Registry. The blue dashed line indicates the Hubstatewide average. The data label represents individuals for whom data wasavailable (denominator).

Tobacco Use Screening & Cessation*

Figure 14: Presents the proportion, including 95% confidence intervals, ofcontinuously enrolled members that were screened for tobacco use one ormore times within a two-year lookback period and that received cessationcounseling intervention. This figure includes only practices providing clinicaldata to the Vermont Clinical Registry. Hubs do not report to the ClinicalRegistry. The blue dashed line indicates the Hub statewide average. The datalabel represents individuals for whom data was available (denominator).



Breast Cancer Screening*

Figure 15: Presents the proportion, including 95% confidence intervals, ofcontinuously enrolled female members, ages 52–64 years, that had amammogram to screen for breast cancer during the measurement year oryear prior to the measurement year. The blue dashed line indicates the Hubstatewide average. The data label represents individuals for whom data wasavailable (denominator).

Cervical Cancer Screening*

Figure 16: Presents the proportion, including 95% confidence intervals, ofcontinuously enrolled female members, either (a) ages 21–64 that received aPapanicolaou (Pap) test to screen for cervical cancer during themeasurement year or the two years prior or (b) ages 30–64 years whoreceived a Pap test during the measurement year or four years prior. Theblue dashed line indicates the Hub statewide average. The data labelrepresents individuals for whom data was available (denominator).

Follow-Up After Hospitalization for Mental Illness*

Figure 17: Presents the proportion, including 95% confidence intervals, ofcontinuously enrolled members, hospitalized for mental illness with anintensive outpatient encounter or partial hospitalization with a mentalhealth practitioner and a follow-up visit within seven days of discharge. Theblue dashed line indicates the Hub statewide average. The data labelrepresents individuals for whom data was available (denominator). Note: Iffollow-up was provided at a Hub or by Spoke staff, no separate claim wouldbe generated to be counted in this measure.



The following tables provide greater detail on the annual crude rates presented in the preceding figures.

Table 3: Expenditure Measures (Crude Rates)

Measure

Hub Spoke Non-MAT OUD

Rate perCapita 95% LCL 95% UCL



Total $15,779 $15,190 $16,369 $17,725 $17,236 $18,213 $12,603 $11,737 $13,469

Total Excluding Special Medicaid Services $8,112 $7,630 $8,594 $15,201 $14,802 $15,600 $9,584 $8,888 $10,281

Inpatient Total $2,528 $2,230 $2,825 $1,989 $1,745 $2,234 $2,836 $2,394 $3,278

Inpatient Mental Health $1,118 $913 $1,323 $460 $353 $567 $975 $739 $1,211

Inpatient Maternity $205 $158 $251 $338 $278 $398 $169 $114 $225

Inpatient Surgical $616 $454 $778 $753 $553 $952 $884 $633 $1,136

Inpatient Medical $598 $487 $708 $490 $390 $590 $814 $603 $1,026

Outpatient Total $1,194 $1,123 $1,265 $1,260 $1,188 $1,332 $1,623 $1,499 $1,746

Outpatient Hospital Mental Health $135 $121 $149 $301 $273 $330 $152 $127 $177

Outpatient Hospital ED $515 $482 $548 $367 $341 $392 $551 $505 $597

Outpatient Hospital Surgery $178 $148 $207 $151 $125 $178 $311 $255 $367

Outpatient Hospital Radiology $92 $67 $117 $72 $60 $84 $178 $131 $224

Outpatient Hospital Laboratory $126 $114 $137 $147 $135 $158 $165 $149 $181

Outpatient Hospital Pharmacy $12 $6 $18 $24 $10 $39 $37 $17 $57

Outpatient Hospital Other $117 $101 $133 $132 $114 $149 $189 $162 $217

Professional Non-Mental Health Total $849 $805 $892 $907 $866 $947 $1,131 $1,063 $1,199

Professional Physician Total $525 $492 $558 $630 $598 $662 $716 $665 $766

Professional Physician Inpatient $154 $132 $177 $181 $158 $204 $188 $155 $221

Professional Physician Outpatient Facility $78 $70 $85 $85 $77 $93 $143 $128 $158

Professional Physician Office Visit $172 $162 $183 $285 $271 $299 $267 $247 $287

Professional Non-Physician $314 $296 $332 $274 $259 $290 $410 $382 $439

Professional Mental Health Provider $495 $462 $528 $1,729 $1,676 $1,781 $628 $580 $676

Pharmacy Total $1,995 $1,839 $2,152 $5,982 $5,825 $6,139 $2,333 $2,092 $2,575

Pharmacy Psych Medication $530 $480 $581 $700 $641 $760 $527 $453 $601

Other Total $652 $583 $720 $3,136 $3,010 $3,261 $982 $860 $1,103

Special Medicaid Services $7,422 $7,226 $7,618 $2,343 $2,173 $2,513 $2,808 $2,474 $3,141

Mental Health Substance Combined* $1,895 $1,749 $2,041 $3,173 $3,054 $3,293 $1,994 $1,807 $2,181

* The Mental Health Substance Combined measure is the sum of all expenditures associated with medical and pharmacy services for mental health / substance abuse.

Table 4: MAT Expenditure Measures (Crude Rates)

Measure





Hub Bundled Payment $5,463 $5,376 $5,549 $152 $131 $173 $0 $0 $0

MAT Pharmacy $84 $71 $97 $3,875 $3,800 $3,950 $0 $0 $0

Professional OUD $790 $714 $866 $3,377 $3,274 $3,481 $969 $866 $1,072

Buprenorphine Dispensed in Hub $888 $830 $946 $42 $33 $50 $0 $0 $0

Spoke Staff $39 $34 $44 $1,526 $1,507 $1,545 $0 $0 $0

Urinalysis $179 $154 $204 $1,723 $1,651 $1,794 $228 $191 $266


Table 5: Utilization Measures (Crude Rates)

Measure


Rate per1,000 95% LCL 95% UCL



Inpatient Discharges 281.0 262.6 299.3 213.6 198.3 228.8 274.7 250.9 298.6

Inpatient Days 1,763.5 1,717.6 1,809.4 1,190.1 1,154.2 1,226.1 1,695.4 1,636.1 1,754.7

Outpatient ED Visits 1,181.7 1,144.1 1,219.3 842.4 812.1 872.6 1,214.5 1,164.3 1,264.6

Outpatient Potentially Avoidable ED Visits 204.4 188.8 220.0 134.7 122.7 146.8 208.3 187.6 229.1

Non-Hospital Outpatient Visits 5,297.9 5,218.4 5,377.5 18,519.5 18,377.7 18,661.3 7,497.8 7,373.2 7,622.5

Primary Care Encounters 5,419.9 5,339.4 5,500.4 7,728.5 7,637.0 7,820.1 4,539.9 4,442.9 4,637.0

Medical Specialist Encounters 1,715.0 1,669.7 1,760.2 977.1 944.6 1,009.7 900.9 857.6 944.1

Surgical Specialist Encounters 588.3 561.8 614.9 1,626.0 1,584.0 1,668.0 858.8 816.6 901.0

Standard Imaging 789.0 758.3 819.7 690.4 663.0 717.8 1,105.4 1,057.6 1,153.3

Advanced Imaging 336.3 316.3 356.4 274.6 257.3 291.8 488.5 456.7 520.3

Echography 431.8 409.1 454.6 478.0 455.2 500.7 443.1 412.8 473.5

Colonoscopy 13.4 9.4 17.4 9.9 6.6 13.2 28.1 20.4 35.7

PQI 5: COPD Admissions 17.5 8.7 26.2

PQI 8: Heart Failure Admissions

PQI 92: Composite (Chronic) 8.6 5.4 11.8 8.8 5.7 11.9 8.1 4.0 12.2

Ambulatory Care ED Visits - HH 1,613.2 1,569.3 1,657.1 1,116.9 1,082.1 1,151.8 1,747.8 1,687.6 1,808.0

Inpatient Utilization - HH 233.0 216.3 249.7 188.4 174.1 202.7 221.3 199.9 242.7

Short-Term Nursing Facility Admissions-HH 7.6 3.6 11.5

Long-Term Nursing Facility Admissions-HH

Table 6: Effective & Preventive Care Measures

Measure


N Rate95%LCL

95%UCL N Rate

95%LCL

95%UCL N Rate

95%LCL

95%UCL

Breast Cancer Screening - HH 70 36% 24% 48% 78 42% 31% 54% 93 48% 38% 59%

Cervical Cancer Screening - HH 825 54% 50% 57% 973 59% 56% 62% 452 58% 53% 62%

Follow-up After Hospitalization for Mental Illness (7 Day) - HH 175 19% 13% 26% 93 20% 12% 29% 86 23% 14% 33%

Controlling High Blood Pressure - HH 97 60% 50% 70% 140 61% 52% 69% 92 60% 49% 70%

Adult Body Mass Index Assessment - HH 1,360 89% 87% 91% 1,543 90% 88% 91% 731 91% 89% 93%

Screening for Clinical Depression - HH 1,267 2% 1% 2% 1,520 3% 2% 4% 714 7% 5% 9%

Tobacco Use Screening & Cessation - HH 2,081 12% 11% 13% 2,355 12% 11% 13% 1,228 18% 15% 20%

Table 7: Plan All-Cause Readmissions

Measure


NObserved /

Expected Ratio LCL UCL NObserved /

Expected Ratio LCL UCL NObserved /

Expected Ratio LCL UCL

PCR 369 1.18 0.97 1.38 338 0.62 0.40 0.85 194 1.21 0.91 1.52


Hub Case Load Growth

Figure 18: Presents the total members per year receiving at least one Hubmedical claim within the reporting period and the percent cumulative growthrelative to 2008.

Spoke Case Load Growth

Figure 19: Presents the total members per year receiving at least oneprescription for buprenorphine as identified in the pharmacy claims withinthe reporting period and the percent cumulative growth relative to 2008.

MAT Case Load Growth

Figure 20: Presents the total average members per year receiving at leastone prescription for buprenorphine as identified in the pharmacy claims or atleast one hub treatment medical claim within the measurement year and thepercent cumulative growth since 2008.

Medicaid Enrollment & MAT Treatment

Figure 21: Presents the average number of Medicaid enrollment monthsamong MAT participants, the average number of MAT treatment months,and the percent of Medicaid enrollment months in which the memberreceived treatment. MAT participation and Medicaid enrollment remainedstable from 2008–2017 despite enhancements and changes made to theMAT program.


Percentage of Vermont Residence Receiving Medication Assisted Treatment (State Fiscal Year 2017)

Figure 22: Presents the percentage of residents receiving MAT for OUD within each county. Shadingindicates whether the rate of MAT participation was statistically higher, lower, or similar to thestatewide average. This figure and calculations are produced by the Vermont Department of Healthand is a non-claims measure of statewide access to treatment.

Documents

Period: Profile Type: Adults (18-64 Years) Non-MAT€¦ · Hub Regional Profile Period: Jan. 2017 - Dec. 2017 Profile Type: Adults (18-64 Years) ... More detail on this measure is